Are We Becoming an Opioid Nation? A Smarter Way to Take Painkillers

Last week, the White House’s Commission on Combating Drug Addiction and the Opioid Crisis issued a stark recommendation to President Trump—“declare a national emergency under either the Public Health Service Act or the Stafford Act.” With “approximately 142 Americans dying [of drug overdose] every day,” the report continued, “America is enduring a death toll equal to September 11 every three weeks.”

As the administration scrambles to respond, with Trump planning to hold a major briefing with top officials at his private golf club this afternoon, and the First Lady taking to Twitter with a public vow of support, Americans may find themselves wondering how a seemingly innocuous orange bottle of Percocet, Vicodin, or Demerol in one’s medicine cabinet could contribute to a national health epidemic. But lest one think the situation is exaggerated, consider this fact: According to one recent federal study, prescription painkillers were more common in 2015 than tobacco—as in cigarettes, cigars, and smokeless tobacco, combined.

New national standards set by the Centers for Disease Control and Prevention (CDC) aimed to limit access to the addictive painkillers—which act on similar brain systems affected by heroin and morphine, making them particularly habit-forming—by advising doctors to avoid prescribing them for long-lasting or chronic pain, to limit supplies for short-term use to three days, and to avoid writing scripts for longer than seven days.

But what about when they’re actually necessary? Opioids can be a valid course of treatment to manage the immediate acute pain caused by anything from oral surgery to, say, a broken leg. And they’re often the only thing that really works post-surgery, according to Dr. Marvin Seppala, chief medical officer at the Hazelden Betty Ford Foundation. “Surgical wounds heal better if you take care of pain,” he says. “If you don’t, you get tense, muscles don’t form back correctly, and you can’t heal.”

Across the board, experts agree, awareness is the key to properly managing any potentially addictive medication. For those looking for a quick synopsis on how to take the prescriptions responsibly, when to avoid them, or what alternatives to pursue, here’s a guide to understanding the short-term painkillers and how best to use them.

Understand the backstory.Dr. W. Clay Jackson, vice president of the board at the American Academy of Pain Management, says those suddenly facing acute postoperative pain or a new injury who are panicked about whether to take a few days’ worth of opioids for short-term recovery should understand how this current crisis came about. He explains it’s the result of practices beginning in the mid-1990s, when doctors began using opioids for long-term, non-cancer–related chronic pain that lasted more than three months (rather than just for short-term acute pain). Now, he says, doctors realize that this practice has often backfired, leading to worsened conditions and sometimes even addiction. This triggered the new CDC rules that have led some states, including Massachusetts, to limit opioid prescriptions to a seven-day supply and allow patients to voluntarily reduce the amount of pills they receive from the pharmacy.

Create a plan.If you find yourself in pain and clutching a script for three to seven days of opioids, you’ll first want to evaluate your ability to take them correctly. Seppala says most doctors leave you some leeway to decide how to take newly prescribed opioids based on your pain (the standard formula: Take one to two every 4 to 6 hours). “But, if you’ve had previous addictions or a genetic link to addiction in the family, you’re at a higher risk than the general population,” he adds. In this case, Seppala recommends discussing your background with the prescribing doctor to agree on a structured plan that doesn’t allow you to make independent decisions to increase dosages. “Also, involve someone else in your life who will monitor the meds with you; you’re not thinking clearly when you’re in pain,” he adds.

Anticipate withdrawal.When you take an opioid, it works. That’s one main reason the drugs have been so widely prescribed. But, Seppala says, everybody develops tolerance, and everybody will have withdrawal symptoms—that’s not addiction, that’s a physiological response. If you stop suddenly, you may experience upset stomach and vomiting, which is why tapering is your best bet. (Even if you do, however, sleep can become disrupted, and anxiety may set in.) Under the new guidelines, you’ll most likely be taking a short course of the meds before a doctor-supervised tapering; you can start tapering days after oral surgery, though orthopedic procedures like knee replacements combined with aggressive post-op physical therapy can require a longer course of meds. Schedule a return visit to the doctor after a few days or a week (depending on your prescription length) to be sure everything is healing correctly, then find out if your community has a medicine take-back program and get rid of the extra pills.

Consider alternative therapies.High doses of ibuprofen and aspirin can sometimes be effective under doctor supervision, though Jackson warns that longer-term use can harm kidneys or damage gastrointestinal tracts. Dr. Wendye Robbins, clinical associate professor at Stanford University Medical Center’s Systems Neuroscience and Pain Laboratory, says though she’d studied their effects, she had never taken an opioid herself until she had foot surgery a few years ago. “I got OxyContin and felt nauseous. I was much happier with the local anesthetic nerve block I got during surgery,” she says. Jackson, Robbins, and Seppala favor holistic recovery plans that also incorporate physical therapy, meditation, and counseling. Robbins adds, “You want to get patients back to their former selves, without the drugs, as soon as possible.”